{"id":2263,"date":"2016-06-02T14:48:58","date_gmt":"2016-06-02T14:48:58","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=2263"},"modified":"2026-03-11T05:20:43","modified_gmt":"2026-03-11T10:20:43","slug":"how-group-practices-are-surviving-the-value-based-payment-model-in-2016","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/how-group-practices-are-surviving-the-value-based-payment-model-in-2016\/","title":{"rendered":"How group practices are surviving the value based payment model in 2016!"},"content":{"rendered":"
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Group Practices & Value-Based Federal\/Commercial Policies!<\/a> <\/strong> from Billingparadise<\/a><\/strong><\/div>\n

As the healthcare industry undergoes dramatic transformation, group practices are facing a lot of turbulence to their financial structuring. Moving away from fee-for-service business models to value-based reimbursement setup is a daunting endeavor, but, that\u2019s where the industry is heading towards.<\/p>\n

Health and Human Service (HHS) states that \u201c90 percent of Medicare payments to be tied to value-based models by 2018\u201d<\/p>\n

This value-based approach is an ambitious maneuver<\/a>, however if done right, will lower healthcare costs dramatically and improve the quality of care while at it.<\/p>\n

But, moving away from fee-for-service (FFS) is putting capitation risks on to the group practices. And, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) \u201chas mandated providers to take payment risk over the coming years\u201d. Meaning, getting paid is going to get a lot more difficult.<\/p>\n

But, this is an environment where group practices have little to no experience to operate in, for that matter, even the payers are in murky waters.<\/p>\n

Commercial\/Federal Payment Models & Regulations<\/span><\/h3>\n

According to the respondents of an AMGA (American Medical Group Association) survey \u201cIt is expected that FFS payments from both Federal and commercial payers will decrease by about 24 percent by 2017\u201d<\/p>\n

On aggregate group practices would need at the least 2-4 years to start accepting these risk based systems. And, that is, provided the payers will be willing to give the group practices risk-based solutions. The survey continues by stating that \u201call risk arrangements are expected to increase by more than twofold by 2017\u201d<\/p>\n

Commercial:<\/span> <\/span><\/h4>\n

With commercial payers, the bundle payment arrangements are getting to be more and more common. It is estimated that it will be playing an even larger role by 2018.<\/p>\n

Some challenges felt through the current commercial setting:<\/span><\/h4>\n